Internal Medicine PGYI

Description of Rotation or Educational Experience

The purpose of the Internal Medicine rotation is to familiarize the PGYI resident with the diagnosis, treatment and management in the inpatient care setting of acutely and critically ill adults, and give the resident confidence in patient care in a well supervised, one-to-one environment, with an internist. Each PGYI resident will complete a four-week rotation at the Veterans Administration Medical Center in Fayetteville in the inpatient setting following acutely and critically ill adults under the direction and supervision of one of five board certified Internists (Dr. Soe Win, Dr. Bang Hoang, Dr. Michael Griffey, Dr. Drake Rippelmeyer or Dr. Paul Provaznik).  Longitudinal internal medicine experience will occur throughout the three-year residency in each resident’s continuity clinic in the FMC.

Goal I: To achieve competence in diagnosing and managing common medical conditions as appropriate for the Family Physician.

Goal II: To achieve competence in recognizing and referring complex medical disorders.

Goal III:  To emphasize physician responsibility and professionalism.

Goal IV: To recognize the role of teamwork and systems pertaining to hospitalized patients.

The resident is expected to:

• Perform 2-3 history and physical exams each day
• Write orders on 8-12 patients per day
• Attend weekly didactic lectures presented by Dr. Rippelmeyer

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to have a measurable and progressive knowledge of the following:

Competencies

Top Disease Processes

• COPD
• Pneumonia
• Angina
• MI
• Heat Failure
• Atrial Fibrillation
• Pancreatitis
• GI Bleed
• Stroke
• TIA
• Sepsis
• Syncope

Objectives

The resident will:

• Know the signs and symptoms of the disease.
• Define a differential diagnosis of the disease.
• Identify the proper labs and test to order and understand their meaning in diagnosing the disease.
• Define a treatment plan for the disease.
• Know how to prevent the diseases.
• Demonstrate an ability to describe the basic pathophysiology, prevention, and management of the disease to patients and their families.
• Demonstrate physician responsibility to his/her patients.
• Describe the indications for venipuncture, lumbar puncture, arterial puncture, thoracentesis, nasogastric intubation, and paracentesis and special procedures vital to management of the critically ill adult patient.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and socio-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

CATEGORY A                                                               CATEGORY B                                                      

1.         Coronary Heart Disease                                                 1.         Headache                                             

2.         Fluid/Electrolyte Management                                        2.         Hypertension                                        

3.         Acute Respiratory Failure                                               3.         Asthma                                                                

4.         Pulmonary Embolism                                                     4.         COPD                                                                    

5.         Renal Failure                                                                 5.         Monitoring Anticoagulation                         

6.         Pneumonia                                                                                Treatment                                                

7.         Diabetic Ketoacidosis                                                     6.         Arthritis                                                                

8.         Congestive Heart Failure                                                 7.         Urinary Tract Infection                            

9.         GI Bleed                                                                        8.         Abdominal Pain                                    

10.        Seizure Disorders                                                          9.         Anemia                                                

11.        Neurologic Emergencies                                               10.        Monitoring Diabetes as Outpatient              

12.        Cardiac Dysrhythmias/EKG                                          11.        Chronic Pain                                         

  Interpretation                                                              12.        Allergy                                                                 

13.        Hemoptysis                                                                 13.        Dietary Management/Nutrition                    

14.        Connective Tissue Disorders                                         14.        Irritable Bowel Syndrome                           

15.        Cerebrovascular Disease                                              15.        Sleep Disorders                                    

Objectives

• The resident over three years will become competent to diagnose and treat common diseases that require hospitalization by the Family Physician.
• The resident will learn limitations, when consultant is necessary and how to obtain a consult.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Identify and perform appropriate learning activities.
• The residents will identify strengths and limits of knowledge by progressive increases in their knowledge base.  This will be measured by successful completion of USMLE step 3, in-training exam score, and preceptor evaluation.
•  Use information technology to optimize learning.

Objectives

·         The resident will, with combined experiences throughout residency, acquire progressive responsibility and knowledge.

·         In-Training Exam and Core Content Review will identify specific weaknesses.

• The resident will become competent in the use of UpToDate, DynaMed, and journal searches. 
• The resident will become competent in the use of EMR to track patients, recover lab data and medical reports.  The resident will become competent to use the PDA with Epocrates and 5-Minute Medical Consult.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work in interdisciplinary teams to enhance patient safety and improve patient care quality.
• Work to control health care costs and allocate resources to provide high quality care.
• Support the individual and family through consultation, evaluation, treatment and rehabilitation services.

Objectives

• The resident will learn the different healthcare settings and systems (VA System, Rehab Hospital, Skilled Nursing Facility, Nursing Home) and how to move their patients easily to the best setting for the patient.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others.

Objectives

• The resident will be mentored by the faculty to teach the role of compassion, integrity, and respect in care of the adult with acute and chronic problems.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies.

Objectives

The resident will learn appropriate consultation, timely transfers, and other options of care for acute and chronic problems.  This will be monitored on rounds.

Teaching Methods

Inpatient rounds with preceptors, didactic lectures by Dr. Rippelmeyer on various internal medicine topics as well as interesting cases, performance of procedures under the supervision of preceptors and lectures.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References available at the AHEC Library:

Bennet JC, Goldman L. Cecil textbook of medicine. 21^st ed. Philadelphia, Sounders

Fauci, A, et al. Harrison’s principles of internal medicine. 14^th ed. New York, McGraw-Hill

Rakel, RE. Saunders manual of medical practice. 2nd ed. Philadelphia, Saunders

Washington University School of Medicine. Department of Medicine. Washington manual of medical therapeutics. 29^th ed. Philadelphia, Lippincott-Raven

On Line Resources:

UpToDate and DynaMed